Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 28171978A | IN |
N | 363LC1500X | Nurse Practitioner - Community Health | 28171978A | IN |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 28171978A | IN |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 28171978A | IN |
NPI | 1720418080 |
---|---|
Provider Name | Mrs. Alexis Ann Manring |
First Address | Anderson, IN 46012-5106 |
Second Address | Anderson, IN 46012-5106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2013 |
Last Update Date | 09/07/2019 |